The No Surprise Act and Good Faith Estimates
Understanding your health insurance can seem overwhelming at times, especially
during an emergency.
Too often, we hear stories of patients who unknowingly visit an out-of-network
doctor or emergency room when
traveling, only to be surprised by large medical bills when they get home.
Thanks to the No Surprise Act, which went into effect January 1, 2022,
these surprise medical bills are now a thing of the past.
The No Surprise Act protects patients from surprise medical bills that
arise when they unintentionally receive care from out-of-network hospitals,
doctors or `other providers they did not choose. It does this by:
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Requiring private health plans to cover these out-of-network claims and
apply in-network cost-sharing.
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Prohibiting doctors, hospitals and other covered providers from billing
patients more than in-network cost-sharing amounts.
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Establishing a process for determining the payment amount of surprise,
out-of-network medical bills. This process begins with negotiation between
plans and providers.
The No Surprise Act also protects patients who don’t have or are
not using insurance. It requires healthcare providers to give these individuals
a Good Faith Estimate of the bill for medical items and services. Important
things to know about Good Faith Estimates:
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They will include the total expected cost of any non-emergency items or
services. This includes related costs like medical tests, prescription
drugs, equipment and hospital fees.
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They should be received in writing at least 1 business day before the medical
item or service.
For more information on the No Surprise Act and Good Faith Estimate, visit
www.cms.gov/nosurprises or call 1-800-985-3059.